Robert Zakar gives back to community

Better Late Than Never

By Wolf BlitzerCNN Wolf Blitzer Reports

WASHINGTON (CNN) -- It's a case of better late than never. I'm referring to the federal government's war against bioterrorism. In his just-released budget, President Bush has proposed nearly $6 billion to fund that war. That's a three-fold increase over the current budget. Experts who have studied where the money is being directed are impressed.

One of those experts is Dr. Michael Osterholm, the director of the University of Minnesota's Center for Infectious Disease Research and Policy. He has been in the forefront in warning of the dangers of bioterrorism for years. Long before September 11 and the subsequent anthrax-laced letter attacks, he was sounding the alarm. His book, "Living Terrors: What America Needs to Know to Survive the Coming Bio-terrorist Catastrophe," was written long before most of us had focused on the problem. His bottom line point is that the United States was simply not prepared for a bioterrorist attack before September 11. "We had a skeleton system, something you heard many of us say to you multiple times on your programs," he told me this week. "And I think that now we can feel very pleased with the fact that we're getting it right. We are now developing a system in this country that will help protect its citizens from infectious diseases across the board, both in terms of new research and development, in terms of vaccines, antibiotics, and test methods." Dr. Osterholm is impressed that the Bush administration is not simply throwing money at the bioterror threat. He says the government is following a well-thought-out blueprint laid out by the top public health experts in the country. "We're quite pleased to see that they actually are following that blueprint," he says. "There's no politics involved with this." In my daily column for CNN.Com, I will share some perspective on the day's news, including behind-the-scenes background and details of conversations I've had with newsmakers. You will be able to find it right here every Monday through Friday. I'd love to get your feedback. You can always email me at wolf@cnn.Com.Return to:>>CNN.Com mainpage>>CNN.Com U.S. Section He continued: "We're talking about new surveillance systems that will allow us to quickly pick up these diseases and have a much more comprehensive response. And most of all, we're talking about then having that system in place that could have surge capacity -- meaning that if something did happen requiring hundreds of thousands to millions of people need to be vaccinated, we can do it. We can now look in the eye of the American citizen and say we can be prepared." That is very encouraging to hear -- especially from someone as knowledgeable about the subject as Dr. Osterholm. One of the great things about my job is that I have the opportunity to question smart people. I almost always learn something in the process -- and I hope you do as well. Wolf Blitzer

COVID-19, A Disease With Tricks Up Its Sleeve, Hasn't Fallen Into A Seasonal Pattern — Yet

A woman squeezing the sample liquid on a test strip while carrying out a COVID-19 rapid self test at home. (Tang Ming Tung/Getty Images)

To most people on the planet, the COVID-19 pandemic is over. But for many scientists who have been tracking the largest global infectious disease event in the era of molecular biology, there is still a step that the virus that caused it, SARS-CoV-2, hasn't yet taken. It has not fallen into a predictable seasonal pattern of the type most respiratory pathogens follow.

Influenza strikes — at least in temperate climates — in the winter months, with activity often peaking in January or February. In the pre-COVID times, that was also true for RSV — respiratory syncytial virus — and a number of other bugs that inflict cold- and flu-like illnesses. Some respiratory pathogens seem to prefer fall or spring. Even measles, when that disease circulated widely, had a seasonality in our part of the world, typically striking in late winter or early spring.

To be sure, you can contract these viruses at any time of the year. But transmission takes off during a particular pathogen's season. (The COVID pandemic knocked a number of these bugs out of their regular orbits, though they may be heading back to more normal transmission patterns. The next few months should be telling.)

It's been widely expected that SARS-2 will ease into that type of a transmission pattern, once human immune systems and the virus reach a sort of detente. But most experts STAT spoke to about this question said that, so far, the virus has not obliged. Their views differ on the margins. Some expect seasonality to set in soon while others don't venture to guess when the virus will settle into a seasonal pattern.

"I don't see clear seasonality for SARS-CoV-2 yet," Kanta Subbarao, director of the World Health Organization's Collaborating Centre for Reference and Research on Influenza at the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia, said via email. Subbarao is also chair of the WHO's technical advisory group on COVID-19 vaccine composition, an independent panel that recommends which version or versions of SARS-2 should be included in updated COVID vaccines.

Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, agreed. "There just isn't a definable pattern yet that would call this a seasonal virus. That's not to suggest it might not be some day."

'At the moment I don't think COVID is predictable but it is showing all the signs of becoming the fifth 'human coronavirus' along with OC43, NL63, 229E and HKU1.'Ben Cowling, infectious diseases epidemiologist, University of Hong Kong

Maria Van Kerkhove, the WHO's technical lead for COVID, told STAT in a recent interview that the lack of seasonality is clear. "We expect there to be some seasonality in the coming years. Just based on people's behavior, perhaps, just because it's respiratory," she said. Van Kerkhove does, though, think there are hints of a transmission pattern that is coming into view, something she and others refer to as "periodicity."

"If you kind of squint, you could see a little, you know, in different places," Van Kerkhove said. "I think you can see sort of waves of infection every five, six months or so depending on the population. But that isn't at a national level. … And it's not hemispheric."

Questions posed over SARS-2's lack of seasonality aren't purely academic. Knowing when to expect a disease is critical for health care labor force planning. The tsunami of RSV-infected babies struggling to breathe in the late summer and early fall of 2022 was made worse by the fact that hospitals weren't as prepared as they could have been; they normally see RSV peaks in the winter months. Likewise, knowing when to expect SARS-2 surges helps the Food and Drug Administration and the Centers for Disease Control and Prevention time the rollout of COVID booster shots. The protection against infection generated by the vaccines wanes quickly, so giving them too soon or too late would undermine the efficacy of this countermeasure.

Van Kerkhove thinks waning immunity in the population is the reason for the periodic swells of transmission. Protection against severe disease — whether induced by infection, vaccination, or the two combined — appears to hold up reasonably well. But when it comes to SARS-2, protection against basic infection is short-lived. That's not a surprise given what's known about the four human coronaviruses that predate the arrival of SARS-2. A study in the Netherlands that followed healthy volunteers for more than 35 years found that people can be reinfected with human coronaviruses within about a year after infection, and sometimes after a mere six months. With SARS-2, there are reports of intervals that are shorter still.

Michael Mina, an infectious diseases epidemiologist who previously taught at the Harvard School of Public Health, is a bit of an outlier in this conversation. He believes SARS-2 has been displaying seasonal behavior for a while, though what he describes sounds like the periodicity that Van Kerkhove and some other experts speak of.

Mina thinks of seasonality in terms of predictability, "that certain periods of time are going to see increases and decreases, but not necessarily that it has to just be winter or summer."

"I don't think I use the word wrong but I don't think it's well defined one way or the other," he noted.

Ben Cowling, an infectious diseases epidemiologist at the University of Hong Kong, also thinks seasonality and predictability are intertwined. He doesn't think SARS-2 is there yet — but believes it's on its way.

"At the moment I don't think COVID is predictable but it is showing all the signs of becoming the fifth 'human coronavirus' along with OC43, NL63, 229E and HKU1," he said in an email, ticking off the names of the four human coronaviruses that predated SARS-2.

Osterholm doesn't agree, arguing that even if they follow a pattern, swells of COVID cases at different points in a year doesn't equate to seasonality. Furthermore, he noted that the patterns we've seen to date have been largely tied to the emergence of new variants, like Beta, Delta, and Omicron, with large surges of infections when those versions of SARS-2 arrived in the spring, summer, and late autumn of 2021 respectively.

"It wasn't tied to some kind of environmental conditions. And that's what you often think of with seasonality," Osterholm said.

It's thought that with new viruses, the vast number of susceptible people allows a virus to override conditions that would constrain more established pathogens — kids being out of school, unfavorable atmospheric conditions — and transmit at a time when it normally should not be able to. Epidemiologists refer to this override capacity as the "force of infection."

That, in turn, can impact the ability of other pathogens to transmit during their accustomed times, as was the case with COVID's disruption of flu and RSV. "When a virus is in a pandemic mode, there are forces occurring that we just don't understand," Osterholm said.

There are a number of theories about why some viruses hew to a seasonal pattern. It's thought an interplay of factors is at work. Some have been mapped out, others remain in the realm of the unexplained.

Some relate to human activities, like school, that bring together lots of children, who are expert at amplifying respiratory pathogens. Or holiday travel, potentially. Marion Koopmans, head of virology at Erasmus Medical Center in Rotterdam, the Netherlands, noted that a study published in Nature suggested that a surge in Covid cases in the summer of 2020 in Europe was likely due to people vacationing. "Without detailed analysis, I do not think we can rule out that what we see is 'holiday traffic,'" Koopmans said, referring to the upticks of cases that have been reported every Northern Hemisphere summer since 2020.

Environmental factors are also thought to be at play. The lack of humidity in the air in cold winters affects the integrity of mucus membranes, and it allows viruses to survive better outside a human host. People in temperate climates crowd together indoors during the winter, often in settings where air quality is suboptimal. Interestingly, the defined flu seasons that the Northern and Southern Hemispheres experience are not observed in tropical climates, where transmission occurs on a more year-round basis, without the sharp peaks seen in temperate zones.

"There is now a much stronger evidence base on the impact of climate variables (esp. Temperature, humidity) on pathogen survival and how this translates to an impact on transmission in the population," Nick Grassly, an infectious diseases modeler at the school of public health at Imperial College London, said in an email. "The focus has been much more on environmental drivers (particularly humidity, temperature, rainfall, etc.) than human behavior."

Grassly is one of the people who thinks SARS-2 seasonality is falling into place, noting that the Joint Committee on Vaccination and Immunisation — Britain's equivalent of the Advisory Committee on Immunization Practices, an expert committee that helps the CDC craft vaccination use guidelines — is now recommending a targeted autumn COVID vaccination campaign for high-risk individuals, in anticipation of a surge of COVID activity this winter. A similar, though more broadly aimed campaign is planned for the United States.

"It remains possible that a new variant showing substantial immune escape could spread rapidly, even in summer, and so disrupt seasonal patterns and planning," Grassly noted. "I think it is hard to estimate the probability that this happens, but it would deviate from the recent pattern of successive Omicron variants which have emerged without large increases in overall incidence."

Stanley Perlman, a coronavirus expert whose bona fides in the field stretch back to the pre-SARS-1 days, agrees with Grassly.

'I think that — at this stage — all we can say is that we can assume that there are some seasonal effects … but that we really cannot say the circulation of these viruses is predictable yet, at least not like we have come to know for flu.'Marion Koopmans, head of virology, Erasmus Medical Center

"I think for all these viruses" — human coronaviruses — "they probably circulate all year round. But you get large numbers of infections in the late fall, winter, when people are inside, and they spread. That's what this virus seems to be doing," said Perlman, a professor of microbiology and immunology at the University of Iowa. "As opposed to last summer, the number of cases is way down this summer. And the prediction is they will increase in the late fall, winter again."

A break from seasonal transmission of respiratory pathogens can be a sign something is amiss, with off-season spread having been observed during flu pandemics going back to the Spanish flu pandemic of 1918. The first observed cases in that pandemic occurred in the spring, at a time when flu season would normally have concluded. The 1957 pandemic began in Asia in February of that year, but the virus arrived in, and started spreading through, the United States, during the summer. The 1968 pandemic began in July. The 2009 H1N1 pandemic was first detected in April and the pandemic's major wave ran through the summer, peaked in September and trailed off in October.

"Pandemic influenza doesn't follow a seasonal pattern in any way, shape or form," said Osterholm.

It remains to be seen when it will be apparent that SARS-2 has lost its override capabilities, when we'll feel confident that we know when to expect — plus or minus a month or two — COVID's annual onslaught.

"I think that — at this stage — all we can say is that we can assume that there are some seasonal effects (since we know seasonality does have an effect on other respiratory infections, both by effects on virus stability and on the host) but that we really cannot say the circulation of these viruses is predictable yet, at least not like we have come to know for flu," Koopmans wrote.

This story was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.

COVID Lockdowns Were A Giant Experiment. It Was A Failure.

June 10, 2020, in Williamsburg. Photo: JOHN TAGGART/The New York Times/REDUX

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On April 8, 2020, the Chinese government lifted its lockdown of Wuhan. It had lasted 76 days — two and a half months during which no one was allowed to leave this industrial city of 11 million people, or even leave their homes. Until the Chinese government deployed this tactic, a strict batten-down-the-hatches approach had never been used before to combat a pandemic. Yes, for centuries infected people had been quarantined in their homes, where they would either recover or die. But that was very different from locking down an entire city; the World Health Organization called it "unprecedented in public health history."

The word the citizens of Wuhan used to describe their situation was fengcheng — "sealed city." But the English-language media was soon using the word lockdown instead — and reacting with horror. "That the Chinese government can lock millions of people into cities with almost no advance notice should not be considered anything other than terrifying," a China human rights expert told The Guardian. Lawrence O. Gostin, a professor of global health law at Georgetown University, told the Washington Post that "these kinds of lockdowns are very rare and never effective."

The Chinese government, however, was committed to this "zero-COVID" strategy, as it was called. In mid-March 2020, by which time some 50 million people had been forced into lockdowns, China recorded its first day since January with no domestic transmissions — which it offered as proof that its approach was working.  For their part, Chinese citizens viewed being confined to their homes as their patriotic duty.

For the next two years, harsh lockdowns remained China's default response whenever there was an outbreak anywhere in the country. But by March 2022, when the government decided to lock down much of Shanghai after a rise in cases in that city, there was no more talk of patriotism. People reacted with fury, screaming from their balconies, writing bitter denunciations on social media, and, in some cases, committing suicide. When a fire broke out in an apartment building, residents died because the police had locked their doors from the outside. And when the Chinese government finally abandoned lockdowns — an implicit admission that they had not been successful in eliminating the pandemic — there was a wave of COVID-19 cases as bad as anywhere in the world. (To be fair, this was partly because China did such a poor job of vaccinating its citizens.)

One of the great mysteries of the pandemic is why so many countries followed China's example. In the U.S. And the U.K. Especially, lockdowns went from being regarded as something that only an authoritarian government would attempt to an example of "following the science." But there was never any science behind lockdowns — not a single study had ever been undertaken to measure their efficacy in stopping a pandemic. When you got right down to it, lockdowns were little more than a giant experiment.

June 16, 2020, in Bloomington, Minnesota. Photo: Kerem Yucel/AFP via Getty Images

March 25, 2020, in Chicago. Photo: Taylor Glascock/The New York Times/REDUX

Despite the lack of scientific evidence, lockdowns didn't come out of nowhere, at least not in the U.S. They had been discussed — and argued over — by scientists since 2005, when (as the story goes) President George W. Bush read John M. Barry's book The Great Influenza, about the 1918 pandemic. "This happens every hundred years," Bush is supposed to have said after finishing the book. "We need a national strategy."

In fact, there were people thinking about pandemic mitigation long before Bush read Barry's book. The leader of this ad hoc group was D.A. Henderson, perhaps the most renowned epidemiologist of the 20th century — the man who, decades earlier, had led the team that eradicated smallpox. Richard Preston, the author of The Hot Zone, would later describe this feat as "arguably the greatest life-saving achievement in the history of medicine."

By the time Bush began pushing his administration to come up with a pandemic plan, Henderson was 78 years old. Ten years earlier, he had sat in on a series of top-secret briefings where he listened to a Russian defector describe how he had led a team that was trying to adapt the smallpox virus for bioweapons. Henderson became so concerned that he started a small center focused on biodefense — which meant, in effect, defending against a pandemic. He and his colleagues at the center had spent years trying to persuade government officials to take pandemics seriously — without much success. When the Bush administration began debating what its pandemic strategy should include, it was only natural that Henderson be involved.

The men Bush chose to lead the effort believed that lockdowns could be an important component of a mitigation plan. They were heavily influenced by a model developed by Laura Glass, a 14-year-old high-school student from Albuquerque (aided by her scientist father), that purported to show that keeping people away from one another was as effective as a vaccine. (This story is told, overexcitedly, in Michael Lewis's book The Premonition.)

Henderson vehemently disagreed. For one thing, he didn't trust computer models, which churned out estimates based on hypotheticals. Just as important, they couldn't possibly anticipate the complexity of human behavior. "There is simply too little experience to predict how a 21st-century population would respond, for example, to the closure of all schools for periods of many weeks to months, or the cancellation of all gatherings of more than 1,000 people," he said.

In addition, he felt that the worst thing officials could do was overreact, which could create a panic. In 2006, as the debate inside the Bush administration was nearing its conclusion, he co-authored a paper in a final effort to change the minds of those devising the strategy. The paper concluded: "Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted. Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen as less than optimal, a manageable epidemic could move towards catastrophe."

The Bush team's final document, published by the CDC in February 2007, stopped short of mandating lockdowns but came as close as its authors dared, calling for the use of "social distancing measures to reduce contact between adults in the community and workplace." One of the leaders of the effort, a government scientist named Richard Hatchett, would later tell Lewis what he really believed: "One thing that's inarguably true is that if you got everyone and locked each of them in their own room and didn't let them talk to anyone, you would not have any disease."

Which is true as far as it goes. There were other questions, though, that were at least as relevant. Could the kinds of lockdowns that are achievable in the real world, where hundreds of millions of people can't live in isolation chambers, be an effective tool against a pandemic? Did the virus truly go away during a lockdown or simply hide, waiting to reemerge when it ended? And finally, did the many social, economic, and medical downsides make them, in the aggregate, not worth whatever short-term benefits they might yield?

Henderson, who died in 2016, never stopped making the latter case. "D.A. Kept saying, 'Look, you have to be practical about this,'" says his former deputy, Tara O'Toole. "'And you have to be humble about what public health can actually do, especially over sustained periods. Society is complicated, and you don't get to control it.'"

As the United States gains more and more distance from the COVID pandemic, the perspective on what worked, and what did not, becomes not only more clear, but more stark. Operation Warp Speed stands out as a remarkable policy success. And once the vaccines became available, most states did a good job of quickly getting them to the most vulnerable, especially elderly nursing-home residents.

Unfortunately, there is no shortage of policy failures of which to take stock. We do an accounting of many of them in our new book, The Big Fail. But one that looms as large as any, and remains in need of a full reckoning in the public conversation, is the decision to embrace lockdowns. While it is reasonable to think of that policy (in all its many forms, across different sectors of society and the 50 states) as an on-the-fly experiment, doing so demands that we come to a conclusion about the results. For all kinds of reasons, including the country's deep political divisions, the complexity of the problem, and COVID's dire human toll, that has been slow to happen. But it's time to be clear about the fact that lockdowns for any purpose other than keeping hospitals from being overrun in the short-term were a mistake that should not be repeated. While this is not a definitive accounting of how the damage from lockdowns outweighed the benefits, it is at least an attempt to nudge that conversation forward as the U.S. Hopefully begins to recenter public-health best practices on something closer to the vision put forward by Henderson.

February 3, 2020, in Wuhan, China. Photo: Stringer/Getty Images

After China came Italy, the second country to be hit hard by the coronavirus. The Italian government responded with a lockdown almost as tough as China's. By the time it was lifted, in early June, 34,000 Italians had died of COVID-19, up from 630 when the lockdown was first imposed.

Those were frightening numbers. But when Neil Ferguson saw what had transpired in Italy, he saw an opportunity. For Ferguson, the head of the infectious disease department at Imperial College London, the Italian government's decision to follow China's example meant that lockdowns were suddenly a real-world policy option in Western democratic societies, not just in an authoritarian country like China. As a disease modeler, he believed the same thing Richard Hatchett believed: that if he could lock everyone in a room, the virus would go away. But he had long assumed attempting to do so was politically impossible.

Ferguson is an important epidemiologist, renowned for his estimates, derived from computer models, of possible deaths from a newly emerged virus. As soon as he learned of the outbreak in Wuhan, he and several colleagues began modeling the coronavirus. On March 17, Ferguson laid out the team's findings at a press conference. Their model predicted that, without serious countermeasures, a staggering 81 percent of the population in the U.S. And Britain would become infected, and that 510,000 people in Britain and 2.2 million Americans would die of COVID by late 2020. In addition, the authors wrote, "We predict critical care bed capacity would be exceeded as early as the second week in April, with an eventual peak in ICU or critical bed care demand that is over 30 times greater than the maximum supply in both countries."

For Ferguson, the purpose of the report wasn't just to release their shocking estimates; it was also to push the American and British governments to commit to lockdowns for the long haul. "[T]his type of intensive intervention package," the authors wrote, "will need to be maintained until a vaccine becomes available (potentially 18 months or more) — given that we predict that transmission will quickly rebound if interventions are relaxed."It worked. In the U.K., Prime Minister Boris Johnson had initially planned to keep the country open. Instead, he ordered a lockdown within a week of Ferguson's press conference. (Shortly after Johnson imposed the lockdown, Ferguson was visited twice by his mistress. For obvious reasons, this caused a furor when it was discovered. Ferguson was the first, though hardly the last, Establishment bigwig to ignore the COVID-19 rules they demanded of everyone else.)

As for President Donald Trump, he never used the word lockdown, but he was worried enough to  call for the country to adopt social distancing as a mitigation strategy. Schools, restaurants, businesses — they all closed. White-collar employees who were able to work from home did so. More than once, Trump mentioned that 2.2 million lives were at stake, referring to Ferguson's estimate. Trump's order wound up lasting six weeks.

Most governors issued their own "stay-at-home" orders, usually stricter than Trump's. Even Governor Ron DeSantis in Florida — who would soon become an outspoken opponent of mainstream mitigation measures — reluctantly went along for a brief period. But there were important questions that no one advocating for lockdowns addressed, maybe because in the urgency of the moment the questions didn't occur to them. How long would they last? And even if lockdowns did slow the virus's progression, what would happen when they were lifted?

Regardless, in the space of two months, lockdowns had gone from being unthinkable to being an unquestioned tool in the pandemic toolkit.

March 17, 2020, in Paris. Photo: Veronique de Viguerie/Getty Images

July 5, 2020, in Melbourne. Photo: Asanka Ratnayake/Getty Images

When state public health officials explained to the country's governors why lockdowns were necessary, they talked primarily about "bending" or "flattening the curve." And when governors then explained the strategy to their constituents, they used the same rationale. "If we change our behaviors," said California governor Gavin Newsom in announcing his state's lockdown on March 19, "we can truly bend the curve to reduce the need to surge." The day after Newsom, then-Governor Andrew Cuomo announced a lockdown plan for New York. He called it his PAUSE program — Policies Assure Uniform Safety for Everyone — but really, it was the same thing.

What did flattening the curve mean? Here's what it didn't mean: It did not mean that if people stayed in their homes, COVID-19 would fade away (even if that idea was often suggested in non-expert contexts). Rather, flattening the curve meant delaying the virus spread to prevent hospitals from becoming overwhelmed with COVID patients. During their early press conferences, many governors would display a chart showing a sharp increase in the estimated rate of COVID-19 infections. That's what would happen without lockdowns, they explained. Then they would display a second chart showing a more gradual upturn once lockdowns and other mitigation measures took effect. Simply put, flattening the curve was about helping hospitals manage the crisis rather than ending the crisis. Even those who later criticized lockdowns largely agreed on this point. As David Nabarro, the World Health Organization's COVID-19 envoy (and an eventual lockdown critic), put it, "The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large we'd rather not do it."

In many blue states, however, that rationale was forgotten over time, and many people remained confined to their homes or apartments not just for a few weeks but for a year or more — even after the vaccine became available. And many of the country's biggest cities continually reimposed lockdowns whenever there was an uptick in COVID cases — not just telling people to shelter in place, but also closing small businesses and restaurants, outlawing sports events and social gatherings, and shutting down in-school learning.

Which naturally leads to the obvious question: Did lockdowns help keep Americans alive? Studies were mixed — in their findings, their methodology, even their definition of lockdown. For instance, in August 2020, eClinicalMedicine, an offshoot of the prestigious British medical journal The Lancet, printed a study that concluded that "full lockdowns and wide-spread COVID-19 testing were not associated with reductions in the number of critical cases or overall mortality." In March 2021, Christian Bjørnskov, an economist at Aarhus University in Denmark, compared weekly mortality rates in 24 European countries that used mitigation measures with varying degrees of severity. "[T]he findings in this paper suggest that more severe lockdown policies have not been associated with lower mortality," the economist wrote. "In other words," he added, "the lockdowns have not worked as intended."

Michael Osterholm, the prominent epidemiologist at the University of Minnesota, also doesn't think lockdowns did any good. "There is actually no role for lockdowns," he says. "Look at what happened in China. They locked down for years, and when they finally relaxed that effort, they had a million deaths in two weeks." As for flattening the curve, "that's not a real lockdown," Osterholm says. "You're just reducing contact for a few weeks to help the hospitals."

Dr. Anthony Fauci was probably the best-known defender of lockdowns as a life-saving measure. But the policy continues to have many defenders within the public health establishment. Howard Markel, a doctor and medical historian at the University of Michigan, believes they succeeded. "The amount of lives saved was just incredible," he says. Markel pointed to an August 2023 study by the Royal Society of London that concluded that "stay-at-home orders, physical distancing, and restrictions on gathering size were repeatedly found to be associated with significant reduction in SARS-CoV-2 transmission, with more stringent measures having greater effects."

Still, the weight of the evidence seems to be with those who say that lockdowns did not save many lives. By our count, there are at least 50 studies that come to the same conclusion. After The Big Fail went to press, The Lancet published a study comparing the COVID infection rate and death rate in the 50 states. It concluded that "SARS-CoV-2 infections and COVID-19 deaths disproportionately clustered in U.S. States with lower mean years of education, higher poverty rates, limited access to quality health care, and less interpersonal trust — the trust that people report having in one another." These sociological factors appear to have made a bigger difference than lockdowns (which were "associated with a statistically significant and meaningfully large reduction in the cumulative infection rate, but not the cumulative death rate").

In all of this discussion, however, there is a crucial fact that tends to be forgotten: COVID wasn't the only thing people died from in 2020 and 2021. Cancer victims went undiagnosed because doctors were spending all their time on COVID patients. Critical surgeries were put on hold. There was a dramatic rise in deaths due to alcohol and drug abuse. According to the CDC, one in five high-school students had suicidal thoughts during the pandemic. Domestic violence rose. One New York emergency-room doctor recalls that after the steady stream of COVID patients during March and April of 2020, "our ER was basically empty." He added, "Nobody was coming in because they were afraid of getting COVID — or they believed we were only handling COVID patients."

So in attempting to gauge the value of lockdowns, the most appropriate way is to look not just at COVID deaths but at all deaths during the pandemic years. That's known as the "excess deaths" — a measure of how many more people died than in a normal year. One authoritative accounting was compiled by The Spectator using data gathered by the OECD. It showed that during the first two years of the pandemic — 2020 and 2021 — the U.S. Had 19 percent more deaths than it normally saw in two years' time. For the U.K., there was a 10 percent rise. And for Sweden — one of the few countries that had refused to lock down its society — it was just 4 percent. An analysis by Bloomberg found broadly similar results. In other words, for all the criticism Sweden shouldered from the world's public health officials for refusing to institute lockdowns, it wound up seeing a lower overall death rate during the pandemic than most peer nations that shut down schools and public gatherings. It is not unreasonable to conclude from the available data that the lockdowns led to more overall deaths in the U.S. Than a policy that resembled Sweden's would have.

March 20, 2020, in Los Angeles. Photo: AGUSTIN PAULLIER/AFP via Getty Images

There were other negative consequences too. In the U.S., lockdowns forced hundreds of thousands of small business closures. They exacerbated inequality, as Amazon warehouse workers and meatpackers showed up to crowded workplaces while the "Zoom class" locked down at home. Worst of all, though, it had a devastating effect on children whose schools were closed as part of a lockdown. During the first weeks of the pandemic it probably made sense to close schools given how little was known about the coronavirus. Better safe than sorry. But by the time school started up again in the fall of 2020, two things were clear. The first was that remote learning was a disaster. The second was that there was surprisingly little transmission among kids in school. Well-to-do parents moved their children to private schools, many of which reopened their classrooms. But most big-city public-school systems continued to rely on remote learning well into the 2020–2021 school year. It was a tragic policy choice.

In ProPublica and The New Yorker, the journalist Alec MacGillis vividly described the consequences in Baltimore. With no classrooms to go to, thousands of students abandoned school. The school system made free laptops available, but few students took the trouble to get one. Teachers gave up trying to prod those who didn't log onto their remote classes. Plus, teachers had kids of their own to take care of, which made it difficult to teach.

The anti-lockdown scientist Jay Bhattacharya of Stanford University recalls a photograph in the San Jose Mercury News during the early months of the pandemic. It showed two children, 7 or 8 years old, sitting with Google Chromebooks outside a Taco Bell. "They were on the sidewalk doing schoolwork because that was the only place they could get free Wi-Fi," Bhattacharya said. "Their parents weren't there because they had to go to work. I mean, that should have ended the lockdown right then and there. It should have at least ended school closures."

Public schools have an importance that goes beyond education. It's where many of the rituals of childhood and young adulthood take place. For children who live in unstable homes, school offers some stability. Public schools serve free breakfast and lunch to disadvantaged kids. And they're a place where parents know their children are safe when they're at work. One consequence of lockdowns was that millions of children had to fend for themselves because their parents couldn't afford to quit their jobs to take care of them.

One child psychiatrist, who works with underprivileged autistic kids, began the pandemic believing in the importance of lockdowns and other mitigation measures. But over time, she changed her mind.

"What really drove me was my clinical experience," she said. "What happens to a child when every single support is removed from them? What's the impact on the family and the siblings? What I was seeing was complete regression. It was devastating, and the downsides of lockdowns and school closings were not being openly discussed in the mainstream media. I was horrified. Why aren't we talking about this?" She described the situation she saw as 2022 wore on as a "sickening mental-health crisis."

The science also weighed heavily in favor of opening schools. By mid-summer 2020, when cities were trying to decide whether to reopen schools in September, 146,000 Americans had died of COVID-19. Fewer than 20 were children between the ages of 5 and 14. More schoolchildren died from mass shootings in a typical year. Emily Oster, a Brown University economist, conducted a survey of about 200,000 children who were back in classrooms. The infection rate, she discovered, was 0.13 percent among students and 0.24 percent among teachers — an astonishing low number. Oster then set up what she called the National COVID-19 School Response Dashboard, which eventually tracked 12 million kids in both public and private schools and continued to collect infection-rate data over the next nine months. Not once did the student rate hit one percent during any two-week span.

"We do not want to be cavalier or put people at risk," Oster wrote in The Atlantic. "But by not opening, we are putting people at risk, too."

March 15, 2020, in Manhattan. Photo: VICTOR J. BLUE/The New York Times/REDUX

Over the entirety of the pandemic, the essential facts about schools never changed. The infection rate for teachers in Sweden, where most schools stayed open, was no higher than the infection rate for teachers in Finland, which had closed its schools. In early 2021, three CDC scientists acknowledged in the Journal of the American Medical Association: "As many schools have reopened for in-person instruction in some parts of the U.S. … there has been little evidence that schools have contributed meaningfully to increased community transmission."

So why did so many big-city schools stay closed long after the evidence was clear? There were three reasons. The first, and most understandable, was fear. No matter how small the chance, no parent wanted his or her child to die from COVID-19. And no teacher wanted to become infected while in school and bring COVID-19 home. Because kids often brought colds and flus to school — which then spread to others — both parents and teachers had a hard time accepting that that was not how the virus spread. Here, for instance, was a typical comment from a teacher in Westchester, reacting to a series of New York Times' articles about reopening schools:

Tell me how to get a 6-year-old to not sneeze on his friends let alone play and work from a distance (mucus, saliva, pee, poop, this is all part of our day at the lower levels of education). Tell me how each child is going to have her own supplies for the day as shared supplies are no longer an option. No more Legos, no more books. Tell me how to comfort a hysterical child from a distance of six feet.

That it was well established that the coronavirus was not spread through saliva or pee or by sharing books didn't matter. Too many people were simply unable to judge risk rationally — a problem due in part to unwillingness of government officials to talk honestly about COVID-19. In 2020, for instance, COVID-19 ranked below suicide, cancer, accidents, homicide, and even heart disease as a cause of death for children under the age of 15, according to CDC data. Yet public-health experts did not stress any of this — on the contrary, many of them emphasized instead that children could get COVID-19 without explaining how small the risk was. Is it any wonder, then, that COVID-19 seemed to be the only thing parents and teachers focused on?

The second factor was Trump. On July 6, he tweeted, "SCHOOLS MUST REOPEN IN THE FALL!!" The next day, at a White House event, the president said, "We're very much going to put pressure on governors and everybody else to open the schools. It's very important for our country. It's very important for the well-being of the student and the parents."

In this case, Trump happened to be right; it was important. But by this late stage in his presidency, most Democrats assumed that anything he said was a lie. If Trump said schools should reopen, that was reason enough for them to assume they should stay closed. The sense that opening up was a Trump-endorsed policy seems to have energized opposition to it in blue America — even as data accumulated that the harm being done to the country's children outweighed any potential benefit.

The third reason was the teachers' unions. Public-school teachers were unionized, and their unions — American Federation of Teachers (AFT) and the National Education Association (NEA) — were allies of, and contributors to, the Democratic Party, which dominated most major urban areas. They held enormous sway over big-city school systems.

No one can doubt that teachers were afraid of dying of COVID-19. They truly believed they were putting themselves in harm's way if they went back into a classroom full of children. But instead of helping their members see how small the risk truly was, the teachers' unions embraced the fight to keep teachers away from the classroom.

By the time September 2020 rolled around, at least a dozen of America's biggest cities started the school year remotely. They included Los Angeles, San Francisco, New York, Chicago, and Houston — all cities with the kind of large, disadvantaged communities that would suffer the most if schools were closed. In most cases, city officials said they were trying to move from remote learning to at least a hybrid model, in which students would spend several days a week in classrooms and the rest of the week online.

In school districts that did open their schools that fall, the results were remarkably aligned with Emily Oster's data. In New York, Mayor Bill de Blasio was finally able to get the schools open in late September; between Thanksgiving and the end of the year, the city's positivity rate rose from 3 percent to 6 percent. The positivity rate in the public schools also rose — from 0.28 percent to 0.67 percent. "The safest place in New York City is, of course, our public schools," said de Blasio. To the holdout unions, those numbers didn't matter. Ultimately, only 15 percent of school districts offered full-time classroom instruction during the fall 2020 semester.

By 2022, journalists, academics, and even some public-health officials were finally coming to grips with the enormous damage done to children — especially disadvantaged children — because of remote learning. A lengthy analysis by two professors in The Atlantic toted up some of the issues. First, millions of kids simply gave up on learning. In New York, even after schools had reopened, the chronic absentee rate was 40 percent — up from 26 percent before the pandemic. Studies showed that public-school children got less exercise (no recess) and ate more junk food (no free hot meals) during the pandemic. According to a CDC survey, during the first six months of 2021, nearly half the high-school students surveyed "felt persistently sad or helpless." Parental emotional abuse was four times higher than in 2013, and parental physical abuse nearly doubled, The Atlantic reported.

A study by three major research institutions, including Harvard's Center for Education Policy Research, showed that the longer a school relied on remote learning, the further behind their students were. "In high-poverty schools that were remote for more than half of 2021, the loss was about half of a school year's worth of typical achievement growth," said Thomas Kane, the director of the Harvard center.

Although test scores in 2023 would suggest that students were slowly catchin